Diabetes, ethnicity and gender in the Caribbean

The study of diabetes mellitus in the Caribbean makes an absorbing story and underlines the complexity of both the nature and impact of the disease. The previous and then conventional classification of diabetes mellitus as consisting of juvenile and adult onset varieties did imply a recognition of the non-uniform nature of the disorder but it was in the Caribbean that events highlighted the truly syndromic nature of the disorder. The description in Jamaica shortly after the beginning of the second half of this century of J-type diabetes, a hitherto unrecognized entity, later gained international acceptance and was subsequently categorized as one form of malnutrition related diabetes mellitus. Furthermore, the recognition of this type of diabetes, did not only bring to the attention of the medical world a diabetic patient whose clinical progress was grossly dissimilar to either of the previous two types, but pointed to the reality that in some cases, the development of the disease bore no relationship to any hereditary predisposition. Prevalence rates of diabetes mellitus in the Caribbean over the past five decades have been rising at a rapid pace and despite the use of the much more liberal diagnostic criteria which cmae into use 11/2 decades ago, the increase recorded in countries has been phenomenal. Concomitant with the rising prevalence has been the increasing extent of the impact of the disease on Caribbean communities. The morbidity generated is not only taking a heavy toll on te lives of patients and their families, but also accounts for a larger share of the already scarce resources in the health sectors. The rise of the disease to prominence among the leading causes of death points to its growing contribution to mortality, and its is a contribution that is believed to be underestimated. (AU)

Chronic non-communicable disorders and their impact on Caribbean women - abstract

The second half of this century has witnessed a dramatic change in the pattern of diseases which affect the lives of citizens of the Caribbean countries. Chronic non-communicable diseases have become the leading causes of mortality and premature death; they are also the leading causes of chronic morbidity and disability. Heart disease has been the leading cause of death for the greater part of this century but, over the past thirty to forty years, there have been major changes in the types of pathological processes leading to cardiac disorders. Cancers have moved into second place and cerebro-vascular disease now occupies third place. Hypertension and diabetes are not usually among the main causes of death, but their contribution to mortality is greater and must not be underestimated. This burden of ill-health and its attendant issues is disproportionately shared between the sexes. Caribbean females bear a greater portion of the load in terms of numbers of persons afflicted with the chronic non-communicable diseases; furthermore, the available evidence indicates that this is also true in relation to the severity of manifestations of these disorders. Explanations for the impact of the non-communicable diseases on the lives of people of the Caribbean region revolve around two outstanding facts: firstly, prevalence rates of the leading disorders are high; secondly, measures aimed at control have proven to be inadequate. Population-based studies have demonstrated high prevalence rates of hypertension throughout the region with an average of 30 percent in adults 35 years and over. Studies have also revealed that diabetes exists in 12-15 percent of similar age groups in the population and that, in addition, prevalence of this disorder is increasing. There is an excess of females in both the hypertensive and diabetic populations and, in terms of mortality, women are faring much worse. Coronary artery disease has been a growing clinical problem among both sexes. A comparision of available data reveals that its attendant mortality among Carribbean females is greater than it is among females in North America. The recognition of cancer as the second commonest cause of death in the English-speaking countries and most other Caribbean countries is based on the finding of the increased incidence of malignant dosorders in both sexes. However, a preponderance of females among cancer cases has been demonstrated. Accident-related disorders occupy positions ranging from fourth to sixth. They are responsible for the greatest number of years of life lost in the Region because much younger age-groups are affected. Males bear the brunt of the associated problems, but the incidence among females is rising. The rise into prominence of the chronic non-communicable diseases is the result of the interplay of various factors. However, both the pathogenesis and progress of the leading disorders are intimately related to life-styles. Obesity, a major risk factor for many of these disorders, is a gross example of the result of unhealthy life-styles particularly in women. Improved control of these diseases demands wide-spread changes in styles of living. Caribbean women are well placed in the society to promote the adoption of life-styles which are conducive to health (AU)

Hypertension control in the Caribbean: ethnic, social and public health consequences

In the Caribbean, prevalence rates for hypertension are between 20 and 45 percent for persons aged 45 or over, and 15 percent for persons in the age-group 35-45 years. Minor ethnic differences in its prevalence have been noted. The disorder is generally more common among females and over 90 percent of cases are of the primary (essential) variety. Investigations (renin assays, cellular sodium metabolism studies, etc.) have not made any significant contribution to the search for clues concerning the pathogenesis of this form of hypertension and it is believed that genetic factors, influenced by life-style, are responsible for the high prevalence rates. Hypertension is regarded as the leading single contributor to adult mortality in the region. Strokes are the main cause of death among hypertensives and hypertension is the leading cause of renal failure necessitating renal dialysis in English-speaking countries. Cardiomegaly is the most common complication seen, but congestive cardiac failure is less common than in patients in the developing world. It is believed that this is related to the relatively low incidence of coronary artery disease in the population. However, over the past twenty years, the prevalence of ischaemic heart disease has been increasing. Established cases represent only 50 percent of the total number of hypertensives in the region and there is urgent need for detection programmes. However, the anticipated increase in cases will place a severe burden on the existing inadequate health services. In recent years the English-speaking Caribbean countries has taken a number of measures that should do much to improve the capacity for delivery of health services. The introduction of community aid and nurse practitioner groups has provided welcome and useful addition to manpower; most of the countries have either developed, or are in the process of developing national Formularies; the use of genetic drugs is being widely promoted, and definite steps have been undertaken by some countries to undertake bulk-purchasing of drugs. The importance of education of the public is emphasized and the necessity for mobilization of various sectors to ensure the success of the programme is highlighted.(AU)

Ultrasonography in the diagnosis and management of biliary ascariasis

Biliary ascariasis has traditionally been a poorly recognised clinical entity. Because of unsatisfactory diagnostic tests, most diagnoses are made accidentally by surgeons at laparotomies for evaluation of right upper quadrant pain, often misdiagnosed as cholecystitis. Consequently this has been regarded as a "Surgical" condition. Diagnostic ultrasonography offers a reliable method for evaluating the biliary tree. At ultrasonography, Ascaris lumbricoides can be indentified in the biliary tree and medical management pursued. Follow-up ultrasound studies enable the process of resolution to be monitored and possible complications to be identified. This is the first report on the use of diagnostic ultrasonography in the diagnosis and management of biliary ascariasis in the English-speaking Caribbean, and illustrates the characteristic diagnostic features of the condition. A new sign of biliary ascariasis, 'the can of sausages sign', is also described (AU)

Primary pyogenic liver abscess - abstract

This study was undertaken to identify salient features of pyogenic liver abscesses which were unassociated with a preceding or accompanying infection. Sixteen cases seen between 1973 and 1979 were reviewed. Four presented only with fever. Three of these satisfied the criteria for pyrexia of undetermined origin. Ten presented with fever and hepatomegaly. The latter was usually mild and not associated with tenderness in the right hypochondrium. Two presented with fever and jaundice. Hepatomegaly was noted in one. There were 12 males and 2 females, the youngest was 16 and oldest 65. Jaundice was present in two, pain in four and tenderness over the lower lateral aspect of right chest in nine. Leucocytosis was present in all; SGOT elevated in 7 (of 11); SGPT in 4 (of 11); Alk.Phos. in 2 of 5 cases. The right dome of the diaphragm was elevated in the initial chest X-Ray in 7 (of 14). Liver Scan was positive in all eight cases in which it was performed. All abscesses were in superior portion of right lobe. E. Coli (2), Coliform organisms (1) were cultured but in most cases pus was sterile. Thirteen cases were treated successfully by surgical drainage; one by antibiotics alone. Primary pyogenic liver abscesses, which are almost always present in the upper portion of the right lobe, are found predominantly in males over a wide age span. Tenderness elicited by mild sharp thumps to the lower lateral aspect of the right chest was the most useful sign. Leucocytosis, moderate elevation of SGOT and elevated right dome of diaphragm were the most frequent findings and liver scan was positive in all cases in which it was performed. This series did not yield useful information concerning causative organisms. Good results were obtained from surgical drainage but the condition may be successfully treated by aggressive antibiotic therapy (AU)

Multiple causes of acute glomerulonephritis in children - abstract

The purpose of this study is to stress the fact that acute glomerulonephritis can be produced by various conditions. A review was made of 63 cases of acute nephritis seen in children between the ages of 2 to 13 during the years 1967-1971 at the Spanish Town Hospital. Eight of these cases were considered to be of non-streptococcal origin and were associate with a viral infection in 3 cases, whopping cough in 2 cases and systemic lupus erythematosus in 3 cases. The anti-streptolysin O titre was repeatedly negative in all 8 cases. These results do underline the importance of recognizing acute nephritis as a syndrome. It is believed that the role of Haemophilus Petussis as an aetiologic agent is described for the first time (AU)